ILLUSTRATIVE CASE
A 30-year-old woman presented to the ED after she “passed out” while standing at a concert. She lost consciousness for 10 seconds. After she revived, her friends drove her to the ED. She is healthy, with no chronic medical conditions, no medication use, and no drug or alcohol use. Should she be admitted to the hospital for observation?
Syncope, a transient loss of consciousness followed by spontaneous complete recovery, accounts for 1% of ED visits.2 Approximately 10% of patients presenting to the ED will have a serious underlying condition identified and among 3% to 5% of these patients with syncope, the serious condition will be identified only after they leave the ED.1 Most patients have a benign course, but more than half of all patients presenting to the ED with syncope will be hospitalized, costing $2.4 billion annually.2
Because of the high hospitalization rate of patients with syncope, a practical and accurate tool to risk-stratify patients is vital. Other tools, such as the San Francisco Syncope Rule, Short-Term Prognosis of Syncope, and Risk Stratification of Syncope in the Emergency Department, lack validation or are excessively complex, with extensive lab work or testing.3
The CSRS was previously derived from a large, multisite consecutive cohort, and was internally validated and reported according to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guideline statement.4 Patients are assigned points based on clinical findings, test results, and the diagnosis given in the ED (TABLE4). The scoring system is used to stratify patients as very low (−3, −2), low (−1, 0), medium (1, 2, 3), high (4, 5), or very high (≥6) risk.4
STUDY SUMMARY
Less than 1% of very low– and low-risk patients had serious 30-day outcomes
This multisite Canadian prospective validation cohort study enrolled patients age ≥ 16 years who presented to the ED within 24 hours of syncope. Both discharged and hospitalized patients were included.1
Patients were excluded if they had loss of consciousness for > 5 minutes, mental status changes at presentation, history of current or previous seizure, or head trauma resulting in loss of consciousness. Patients requiring hospitalization secondary to trauma or those from whom an accurate history could not be obtained (eg, intoxication) were excluded, as were patients with a serious underlying condition identified during the original ED evaluation.
ED physicians confirmed patient eligibility, obtained verbal consent, and completed the data collection form. In addition, research assistants sought to identify eligible patients who were not previously enrolled by reviewing all ED visits during the study period.
Continue to: To examine 30-day outcomes...
